1
|
Jalalah SM. Changing Frequency of Glomerular Diseases in Western Saudi Arabia: A 26-Year Experience. J Microsc Ultrastruct 2020; 8:89-95. [PMID: 33282683 PMCID: PMC7703012 DOI: 10.4103/jmau.jmau_64_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 11/17/2019] [Accepted: 01/01/2020] [Indexed: 12/02/2022] Open
Abstract
Introduction: The frequency of glomerulonephritis (GN) is reported to be changing in the world over the past four decades. Few studies arise from the western region of Saudi Arabia. Aims: The aim of this study was to address the frequency of primary GN (1ry GN) and secondary GN (2ry GN) over a period of 26 years in the western region of Saudi Arabia and compare to previous data from other regions of the country. Subjects and Methods: The records of adult renal biopsies, 448 1ry GN and 263 2ry GN, are analyzed. Frequencies of GN subtypes are compared for period 1 (1988–19999) and period 2 (2000–2013). Results: Postinfectious GN (PIGN) and minimal change disease (MCD) show significant changes (P ≤ 0.05). PIGN increased to 6.5% in period 2 from 0% in period 1. MCD decreased to 5.9% in period 2 from 13.5% in period 1. Membranous GN is the most common 1ry GN for both periods with similar percentages (23.8% and 24.2%, respectively). Focal segmental glomerulosclerosis (FSGSC) is the second in period 2 (23%); immunoglobulin A nephropathy at 9.6% became the third, and MCD is the last place instead of the fourth in period 1. Lupus nephritis is the most common 2ry GN. Pooled data from Saudi studies show FSGSC the most common 1ry GN in both periods. Conclusions: The western region of Saudi Arabia presents with a different 1ry GN pattern than the rest of the country that is likely attributed to its unique geographical and environmental characteristics.
Collapse
Affiliation(s)
- Sawsan Mohammad Jalalah
- Department of Pathology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| |
Collapse
|
2
|
Almalki AH, Alrowaie FA, Alhozali HM, Almalki NK, Alsubei AI, Alturki MS, Sadagah LF. Remission and long-term outcomes of proliferative lupus nephritis: retrospective study of 96 patients from Saudi Arabia. Lupus 2019; 28:1082-1090. [DOI: 10.1177/0961203319860584] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Few data are available about the rate of short-term remission and its impact on the long-term outcomes of proliferative lupus nephritis in the Middle East. Methods An observational study was carried out involving 96 adult patients with biopsy-proven focal or diffuse proliferative lupus nephritis (PLN) from four different hospitals. Data on induction, remission and long-term outcomes were collected and analyzed. Results Among the 96 patients with biopsy-proven PLN (median age 27 (IQR: 21,34) years, 85% women and median duration of systemic lupus erythematosus (SLE) prior to diagnosis 27 (IQR: 11, 55) months), 67% developed remission at 6 months (proportion 0.67; 95% CI 0.57, 0.76). Mycophenolate mofetil (MMF) was used in 45/96 (47%), CYC in 41/95 (43%) and other agents in 10/96 (10%). The choice of MMF as induction agent has increased in recent years. Among baseline characteristics, only histologic activity was found to have a significant association with remission, with active lesions more likely to remit than active/chronic and chronic lesions (AOR 6.5, 95% CI 1.44–29.39, p = 0.015). Based on Kaplan–Meier analysis, the 5-year renal survival rate without doubling serum creatinine was 73.8%. Compared to patients with complete remission, lower long-term renal survival rates were observed in patients with no remission (89.7 versus 43%, p = 0.001) and partial remission (89.7 versus 77.6%, p = 0.256). The cumulative rate of doubling serum creatinine, dialysis, relapse and death was 23%, 11%, 10% and 5%, respectively, at 48-month median follow up. Conclusion Approximately two-thirds of patients with PLN develop remission in response to standard induction therapy. Remission was negatively associated with the presence of chronic changes in renal biopsy. Overall, MMF is the most commonly used agent to induce remission; however, with more severe disease CYC, is used more frequently. PLN is associated with significant long-term renal outcomes including a 26% cumulative rate of doubling of serum creatinine at 5 years. Initial remission predicts this long-term renal survival.
Collapse
Affiliation(s)
- A H Almalki
- Department of Medicine, Nephrology Section, King Abdulaziz Medical City, Ministry of National Guard, Jeddah, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Saudi Arabia
| | - F A Alrowaie
- Department of Medical Subspecialties, Nephrology Section, King Fahd Medical City, Riyadh, Saudi Arabia
| | - H M Alhozali
- Department of Medicine, Nephrology Section, King Abdulaziz Medical City, Ministry of National Guard, Jeddah, Saudi Arabia
| | - N K Almalki
- Department of Medicine, Nephrology Section, King Abdulaziz University, Jeddah, Saudi Arabia
| | - A I Alsubei
- Department of Medicine, Nephrology Section, King Abdulaziz Medical City, Ministry of National Guard, Jeddah, Saudi Arabia
| | - M S Alturki
- Department of Nephrology, Alhada Armed Force Hospital, Taif, Saudi Arabia
| | - L F Sadagah
- Department of Medicine, Nephrology Section, King Abdulaziz Medical City, Ministry of National Guard, Jeddah, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Saudi Arabia
| |
Collapse
|
3
|
AlFaadhel T, Alsuwaida A, Alsaad K, Almezaini L, Ahmed N, AlHamad MY, Bakheet A, Wadera J, Mokhtar G, Alsuwaida F, Siddiqui R, Kechrid M, Abdelrehman A, Husain S, Kfoury H, Alabdulsalam A, Alanazi M, Oudah NA, AlHozali H. Prevalence and 20-year epidemiological trends of glomerular diseases in the adult Saudi population: a multicenter study. Ann Saudi Med 2019; 39:155-161. [PMID: 31215222 PMCID: PMC6832335 DOI: 10.5144/0256-4947.2019.155] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Recent international reports have shown significant changes in the incidence of different glomerular diseases. OBJECTIVE Examine temporal and demographic trends of biopsy-diagnosed glomerular diseases in the adult population of Saudi Arabia over the last two decades. DESIGN Medical record review. SETTINGS Four tertiary medical centers in Saudi Arabia. PATIENTS AND METHODS We identified all patients that underwent native kidney biopsy between 1998 and 2017. MAIN OUTCOME MEASURES The frequency and the disease trends in four biopsy eras (1998-2002, 2003-2007, 2008-2011, and 2012-2017) for different glomerular diseases. SAMPLE SIZE AND CHARACTERISTICS 1070 patients, 18-65 years of age; 54.1% female. RESULTS Of 1760 patients who underwent native kidney biopsies, 1070 met inclusion criteria. Focal segmental glomerulosclerosis was the most common biopsy-diagnosed disease, with comparable frequencies over the four eras (23.6%, 19.8%, 24.1%, and 17.1, respectively [ P value for trend=.07]). The frequency of immunoglobulin A nephropathy increased progressively. The incidence of membranoproliferative glomerulonephritis declined significantly. Among the secondary types of glomerular diseases, systemic lupus erythematosus-associated lupus nephritis was the most common, followed by diabetic nephropathy. The prevalence of diabetic nephropathy increased from 1.4% in the first era to 10.2% in the last one. CONCLUSIONS Trends in biopsy-diagnosed glomerular disease have changed. While focal segmental glomerulosclerosis remains the most common glomerular disease, there has been a significant rise in the prevalence of immunoglobulin A nephropathy and diabetic nephropathy. In contrast, membranoproliferative glomerulonephritis has declined. LIMITATIONS Retrospective methodologies are vulnerable to lost data. CONFLICT OF INTEREST None.
Collapse
Affiliation(s)
- Talal AlFaadhel
- From Department of Medicine, College of Medicine King Saud University, Riyadh, Saudi Arabia
| | - Abdulkareem Alsuwaida
- From Department of Medicine, College of Medicine King Saud University, Riyadh, Saudi Arabia
| | - Khaled Alsaad
- From Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Lamees Almezaini
- From Department of Medicine, College of Medicine King Saud University, Riyadh, Saudi Arabia
| | - Noura Ahmed
- From Department of Medicine, College of Medicine King Saud University, Riyadh, Saudi Arabia
| | - Mahmoud Yassin AlHamad
- From Department of Medicine, College of Medicine King Saud University, Riyadh, Saudi Arabia
| | - Ammar Bakheet
- From Department of Medicine, College of Medicine King Saud University, Riyadh, Saudi Arabia
| | - Junaid Wadera
- From Department of Medicine, College of Medicine King Saud University, Riyadh, Saudi Arabia
| | - Ghadeer Mokhtar
- From Department of Pathology and Laboratory Medicine, King Abdulaziz University Hosppital, Jeddah, Saudi Arabia
| | - Feras Alsuwaida
- From Department of Medicine, College of Medicine King Saud University, Riyadh, Saudi Arabia
| | - Rehan Siddiqui
- From Department of Nephrology, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Mohamed Kechrid
- From Department of Nephrology, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Ashraf Abdelrehman
- From Department of Nephrology, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Sufia Husain
- From Department of Pathology and Laboratory Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Hala Kfoury
- From Department of Pathology and Laboratory Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdulrahaman Alabdulsalam
- From Department of Pathology and Laboratory Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Majed Alanazi
- From Department of Internal Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Noura Al Oudah
- From Department of Pathology and Laboratory Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Hanadi AlHozali
- From Deaprtment of Internal Medicine, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| |
Collapse
|
4
|
Glomerulonephritis Pattern at a Jordanian Tertiary Care Center. Int J Nephrol 2018; 2018:2751372. [PMID: 30405912 PMCID: PMC6201331 DOI: 10.1155/2018/2751372] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 09/04/2018] [Accepted: 09/30/2018] [Indexed: 01/17/2023] Open
Abstract
Aim To determine the prevalence and frequency of different pathological patterns of glomerulonephritis (GN) in adolescent (age ≥ 11 years) and adult Jordanian patients. Materials and Methods A retrospective analysis of all clinical and pathological reports of Jordanian patients who had native renal biopsies at the University of Jordan hospital between January 2007 and March 2018 to assess the prevalence and pathological pattern of GN. The data were analyzed statistically using descriptive statistics, the chi-squared test, and Fisher's exact tests. The level of significance was set at P < 0.05. Results Two hundred and nine patients (88 males and 121 females) had native kidney biopsies diagnosed as having GN; the mean age at the time of biopsy was 36.0 ± 14.9 years. Primary GN (51.2%) was more common than secondary GN (48.8%). The most common GN was lupus nephritis (LN) (33.5%), followed by membranous nephropathy (MGN) (15.3%), and diabetic nephropathy (DN) (11.0%). Furthermore, IgA nephropathy was noted in 8.1% of cases. LN was the most common among the secondary GN and occurred in 49.6% of females; MGN was the most common primary GN and occurred in 22.7% of males. There was a statistically significant difference between males and females in the prevalence of LN and MGN (P < .001 and P = .011, respectively). LN was also dominant in all age groups expect for the ≥60 years group, which tended to exhibit DN (40%). Conclusion LN is the most common GN type in Jordan, followed by MGN and DN. MGN is the predominant primary GN with a higher prevalence among males; LN is the predominant secondary GN and tends to occur in Jordanian females. The GN patterns in this study shifted from membranoproliferative GN to MGN in Jordan, which revealed a shift towards similar patterns exhibited in developed countries. Furthermore, DN is the most frequent GN in the elderly.
Collapse
|
5
|
Nazri SKSM, Wong KK, Hamid WZWA. Pediatric systemic lupus erythematosus. Retrospective analysis of clinico-laboratory parameters and their association with Systemic Lupus Erythematosus Disease Activity Index score. Saudi Med J 2018; 39:627-631. [PMID: 29915860 PMCID: PMC6146216 DOI: 10.15537/smj.2018.6.22112] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Objectives: To elucidate the clinico-laboratory characteristics associated with pediatric systemic lupus erythematosus (pSLE) patients with higher Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) score in a retrospective cohort of pSLE patients. Methods: A retrospective study involving 32 pSLE patients was conducted at Hospital Universiti Sains Malaysia, Kelantan, Malaysia between 2006 and 2017. Results: Within the group of 32 pSLE patients, 23 were girls and 9 were boys (3:1 ratio). The most common symptom was renal disorder (n=21; 65.6%) followed by malar rash (n=9; 28.1%), oral ulcers (n=7; 21.9%), prolonged fever (n=5; 15.6%) and arthritis (n=4; 12.5%). Antinuclear antibodies (ANA) were detected in all patients and 25 patients (78.1%) were positive for anti-double stranded DNA (anti-dsDNA) antibodies. Eighteen (56.3%) patients had active SLE (SLEDAI ≥6), and these patients were significantly associated with heavy pyuria (p=0.004), a high ANA concentration (1:160; p=0.040, 1:320; p=0.006), elevated ESR (p=0.006), low C3 levels (p=0.008), oral ulcers (p=0.010), heavy hematuria (p=0.017) and heavy proteinuria (p=0.017), lupus erythematosus (LE)-nonspecific lesion manifestations (p=0.019) and malar rash (p=0.044). Conclusion: Pediatric systemic lupus erythematosus patients with higher SLEDAI score were most significantly associated with pyuria, high ANA titers, and elevated ESR.
Collapse
Affiliation(s)
- Siti Khadijah S M Nazri
- Department of Immunology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kelantan, Malaysia. E-mail.
| | | | | |
Collapse
|